Hip Fractures and Femoral Neck Fractures
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Questions and Answers

What is the primary purpose of core decompression in the context of osteonecrosis?

  • To replace the femoral head
  • To stabilize the hip joint
  • To reduce pain in the knee
  • To increase blood flow to the femoral head (correct)

    • Which of the following factors is NOT associated with THA instability?

  • Soft tissue tension
  • Acetabular alignment
  • Femoral offset
  • Age of the patient (correct)

    • What distinguishes the osteotomy for AVN from traditional osteotomy?

  • It involves partial hip replacement
  • It rotates the femoral head out from under the acetabulum (correct)
  • It does not require postoperative rehabilitation
  • It is a minimally invasive procedure

    • In which scenario is Total Hip Arthroplasty (THA) typically indicated?

    <p>For cases with femoral head collapse</p> Signup and view all the answers

    What percentage range represents the incidence of instability in revision Total Hip Arthroplasty (THA)?

    <p>7-15%</p> Signup and view all the answers

    What is a common timeframe for acute dislocations following Total Hip Arthroplasty?

    <p>Within 3 months</p> Signup and view all the answers

    Which statement is true regarding operative treatments for osteonecrosis?

    <p>Osteotomies reposition the femoral head to reduce pressure</p> Signup and view all the answers

    Which factor is most critical for the alignment of prosthetic components in THA to prevent dislocation?

    <p>Acetabular alignment</p> Signup and view all the answers

    What is the primary treatment for lateral compression pelvic fractures?

    <p>Restoration of pelvic ring</p> Signup and view all the answers

    Which condition can result from damage to joint cartilage during an acetabular fracture?

    <p>Post-traumatic arthritis</p> Signup and view all the answers

    In the context of pelvic fractures, what does SI disruption refer to?

    <p>Anterior-posterior compression injury</p> Signup and view all the answers

    What is a common surgical approach for young patients with hip conditions that might not require THA?

    <p>Nonprosthetic surgical techniques</p> Signup and view all the answers

    What is one symptom that may indicate intra-articular or peri-articular conditions in young hip patients?

    <p>Abductor fatigue</p> Signup and view all the answers

    Which type of fracture requires CT for its assessment?

    <p>Acetabular fracture</p> Signup and view all the answers

    What is the recommended weight-bearing status for an older patient with an insufficiency fracture?

    <p>Weight bearing as tolerated</p> Signup and view all the answers

    Which complication may arise even after perfect reduction of an acetabular fracture?

    <p>Post-traumatic arthritis</p> Signup and view all the answers

    What type of pelvic fracture is associated with a ramus fracture?

    <p>Lateral compression</p> Signup and view all the answers

    In managing pelvic fractures, what is one outdated treatment method?

    <p>Traction/pelvic sling</p> Signup and view all the answers

    What is the initial treatment for a hip dislocation?

    <p>Reduction and bracing</p> Signup and view all the answers

    What is a common characteristic of chronic hip dislocations?

    <p>They generally occur years after total hip arthroplasty (THA)</p> Signup and view all the answers

    Which of the following is NOT a treatment option for a stress fracture?

    <p>Immediate full weight bearing</p> Signup and view all the answers

    What demographic is most commonly affected by hip infections?

    <p>Young children and immunocompromised adults</p> Signup and view all the answers

    Which condition can lead to heterotopic ossification?

    <p>Bone formation in muscle or soft tissue after trauma or surgery</p> Signup and view all the answers

    In which situation is surgical intervention most urgent for a hip infection?

    <p>If septic conditions are suspected</p> Signup and view all the answers

    What is a common injury associated with hip dislocation?

    <p>Knee ligament injury (PCL)</p> Signup and view all the answers

    What imaging finding is indicative of a stress fracture?

    <p>Linear radiolucency</p> Signup and view all the answers

    What is the appropriate management for a patient with an unreduced hip dislocation lasting over 12 hours?

    <p>Immediate reduction is prioritized</p> Signup and view all the answers

    After joint aspiration for hip infection, what laboratory study is typically performed?

    <p>ESR, CRP, CBC</p> Signup and view all the answers

    What is a potential treatment option for heterotopic ossification?

    <p>Indocin and low dose irradiation</p> Signup and view all the answers

    Which of the following situations would most likely require component revision due to hip dislocation?

    <p>Malpositioning of components</p> Signup and view all the answers

    What is the most common type of hip dislocation associated with high energy trauma?

    <p>Posterior dislocation</p> Signup and view all the answers

    What is the common surgical treatment for a stable femoral neck fracture in elderly patients?

    <p>Open reduction, internal fixation</p> Signup and view all the answers

    Which of the following is a possible consequence of a pelvic fracture?

    <p>Life-threatening injuries</p> Signup and view all the answers

    Which classification system is used for assessing nondisplaced and displaced femoral neck fractures?

    <p>Garden Classification</p> Signup and view all the answers

    What is a major complication associated with displaced femoral neck fractures in elderly patients?

    <p>Nonunion</p> Signup and view all the answers

    Which type of fracture is characterized as an unstable intertrochanteric femur fracture?

    <p>Reverse obliquity</p> Signup and view all the answers

    What is the primary non-surgical management approach for patients with osteonecrosis?

    <p>Protected weight bearing</p> Signup and view all the answers

    In young patients, what is a critical step for the surgical treatment of an intertrochanteric femur fracture?

    <p>Anatomic reduction</p> Signup and view all the answers

    Which risk factor is associated with increased mortality risk within one year after a hip fracture?

    <p>Urban living</p> Signup and view all the answers

    What is the typical surgical approach for unstable subtrochanteric femur fractures in young patients?

    <p>Intramedullary nail fixation</p> Signup and view all the answers

    What is the primary management for a low energy impacted fracture in an older patient?

    <p>Non-operative treatment</p> Signup and view all the answers

    What stage in the Ficat-Arlet staging system indicates the presence of subchondral collapse in osteonecrosis?

    <p>Stage III</p> Signup and view all the answers

    What is a distinguishing characteristic of subtrochanteric femur fractures?

    <p>High stress region of the femur</p> Signup and view all the answers

    What immediate postoperative activity is recommended for elderly patients after hip fracture surgery?

    <p>Weight bearing as tolerated</p> Signup and view all the answers

    Which medication class is associated with a risk of osteonecrosis?

    <p>Bisphosphonates</p> Signup and view all the answers

    What is the main focus of non-operative treatment for young patients with osteonecrosis?

    <p>Protecting the femoral head from increased pressure</p> Signup and view all the answers

    Which imaging technique is known for providing bony detail in young hip patients?

    <p>CT scan</p> Signup and view all the answers

    What is a common indication for performing a proximal femoral osteotomy?

    <p>Proximal Femur Malunion/Nonunion</p> Signup and view all the answers

    What is a significant advantage of low-dose CT compared to standard CT?

    <p>Lower radiation exposure</p> Signup and view all the answers

    What factor is crucial when positioning the leg during hip arthrodesis surgery?

    <p>Flexed 15-30 degrees</p> Signup and view all the answers

    Which of the following conditions is treated by a femoral osteotomy?

    <p>Hip dysplasia</p> Signup and view all the answers

    Which statement about labral tears in young adults is true?

    <p>They are present in up to 80% of healthy active adults.</p> Signup and view all the answers

    What is the recommended weight-bearing status after a proximal femoral osteotomy during the healing period?

    <p>Touchdown weight-bearing</p> Signup and view all the answers

    What does a hip arthrodesis provide, particularly for selective patients?

    <p>Adequate pain relief</p> Signup and view all the answers

    Which of the following is a complication associated with hip arthrodesis?

    <p>Ipsilateral knee/ankle issues</p> Signup and view all the answers

    What surgical approach is typically used for hip arthrodesis?

    <p>Anterior approach</p> Signup and view all the answers

    How long should sports be avoided after proximal femoral osteotomy?

    <p>1 year or longer</p> Signup and view all the answers

    What is a common outcome for patients with pre-arthritic hip diseases?

    <p>Structural hip deformity in 90% of patients</p> Signup and view all the answers

    Which of the following options does NOT represent a condition treated by femoral osteotomy?

    <p>Cervical Radiculopathy</p> Signup and view all the answers

    What aspect is important in determining the approach for hip arthrodesis?

    <p>Condition of the hip joint</p> Signup and view all the answers

    Which treatment protocol is typically followed for unstable or displaced fractures?

    <p>ORIF followed by TTWB for 10-12 weeks</p> Signup and view all the answers

    What is a common indicator of intra-articular problems during a physical examination?

    <p>Pain during the impingement test</p> Signup and view all the answers

    What imaging technique is most effective for evaluating intra-articular pathology?

    <p>MRI arthrogram</p> Signup and view all the answers

    What is a notable risk associated with managing pelvic stress fractures in older patients?

    <p>Risk of developing post-traumatic arthritis</p> Signup and view all the answers

    Which patient evaluation technique measures abductor function?

    <p>Bicycle test</p> Signup and view all the answers

    What is the primary goal of treating proximal femoral malunion?

    <p>Restore normal anatomic relationships of the hip</p> Signup and view all the answers

    In the context of post-traumatic hip disorders, which issue may arise from persistent intra-articular pathologies?

    <p>Limited range of motion and function</p> Signup and view all the answers

    What condition is characterized by ossification surrounding a pelvic stress fracture in older patients?

    <p>Stress reaction</p> Signup and view all the answers

    What percentage of recurrent dislocations is associated with malpositioned components in revision Total Hip Arthroplasty (THA)?

    <p>7-15%</p> Signup and view all the answers

    Which soft tissue management strategy is aimed at decreasing hip dislocation incidence after THA?

    <p>Accurate acetabular alignment</p> Signup and view all the answers

    What is a recommended initial treatment for chronic hip dislocations occurring years after Total Hip Arthroplasty?

    <p>Reduction and bracing</p> Signup and view all the answers

    Which component positioning factor is least likely to contribute significantly to unstable total hip dislocations?

    <p>Diaphyseal angle</p> Signup and view all the answers

    What risk factor is most associated with a poor prognosis following a traumatic dislocation of the native hip?

    <p>Vascular disruption</p> Signup and view all the answers

    What type of device is often utilized for recurrent dislocations or instability in hip surgery?

    <p>Constrained ('locked') acetabular component</p> Signup and view all the answers

    When managing a dislocated hip, what is one of the initial evaluations to ensure successful treatment?

    <p>Evaluation of soft tissue integrity</p> Signup and view all the answers

    For patients undergoing Total Hip Arthroplasty, what positioning is recommended for using an abduction brace during recovery?

    <p>Flexed 30-60 degrees, abducted 15 degrees, neutral rotation</p> Signup and view all the answers

    What type of pelvic ring fracture is characterized by being unstable and often requires surgical intervention?

    <p>Vertical sheer fracture</p> Signup and view all the answers

    Which imaging technique is essential for evaluating complex pelvic fractures?

    <p>CT scan</p> Signup and view all the answers

    In the treatment of acetabular fractures, which approach is typically utilized for achieving anatomic reduction?

    <p>Open reduction internal fixation (ORIF)</p> Signup and view all the answers

    What is the recommended weight-bearing status for a patient with an unstable pelvic ring fracture?

    <p>Non-weight bearing (NWB)</p> Signup and view all the answers

    What is the purpose of an abduction brace in the context of managing hip infections?

    <p>To restrict motion and stabilization</p> Signup and view all the answers

    Which of the following laboratory studies is crucial for diagnosing infection of the hip joint?

    <p>Erythrocyte sedimentation rate (ESR)</p> Signup and view all the answers

    Which pelvic fracture type is most commonly associated with high energy trauma and often includes life-threatening other injuries?

    <p>Lateral compression fractures</p> Signup and view all the answers

    What complication may arise if a hip infection is not addressed within the first 24-48 hours?

    <p>Chronic osteomyelitis</p> Signup and view all the answers

    Study Notes

    Hip Fractures

    • Hip fractures are classified as high-energy (young) or low-energy (elderly)
    • High-energy hip fractures are caused by events like motor vehicle collisions (MVC) and falls from a height
    • Low-energy hip fractures are primarily caused by ground-level falls, particularly in elderly patients
    • Low-energy hip fractures occur in 90% of cases
    • Intertrochanteric, subtrochanteric, and femoral neck fractures are common types of hip fractures
    • Elderly patients are at higher risk for low-energy hip fractures. Risk factors include:
      • Increased age
      • Female gender
      • Urban residence
      • Prior hip fracture
      • Alcohol/caffeine use
      • Dementia/delirium
      • Medications
      • Poor nutrition
      • Institutional living

    Femoral Neck Fractures

    • Femoral neck fractures in elderly patients are classified with the Garden Classification with grades I-IV.
      • Types I and II - Non-displaced or impacted fractures
      • Type III - Partially displaced fractures
      • Type IV - Completely displaced fractures
    • Fractures I & II are stable, whereas III & IV are unstable.
    • Stable, non-displaced fractures are treated with open reduction and internal fixation using multiple screws.
    • Unstable, displaced fractures in older patients (>60 yrs) are managed with hemi-arthroplasty or total hip arthroplasty (THA).
    • Complications in femoral neck fractures include:
      • Nonunion (5-25%)
      • Screw cut-out or penetration (4-6%)
      • Avascular necrosis (AVN) (10-40%)

    Intertrochanteric Femur Fractures

    • Similar incidence as femoral neck fractures
    • Occur in elderly patients with osteoarthritis
    • Similar risk factors as those causing femoral neck fractures
    • Low or no risk of AVN
    • Treatment includes stabilization and compression with an intramedullary nail (IMN) or a dynamic hip screw (DHS)
    • Post-operative weight-bearing as tolerated (WBAT) is allowed without ROM restrictions
    • Strengthening is encouraged once the fracture has healed

    Subtrochanteric Femur Fractures

    • Occurs at or below the lesser trochanter of the femur
    • A high-stress region of the femur leading to a higher incidence of delayed union and malunion
    • Treatment options include IMN, fixed angle plate devices, and blade plates
    • Weight-bearing based on fracture stability
    • No hip precautions
    • Complications include loss of fixation and nonunion

    Osteonecrosis of the Femoral Head

    • Avascular necrosis (AVN) is characterized by a vascular insult to the femoral head leading to bone death
    • Primary causes of AVN include medical steroids, alcohol abuse, and trauma
    • Other potential causes include Sickle cell, Gaucher, and myeloproliferative disorders
    • AVN can be staged using the Ficat-Arlet classification, with stage 0 being normal and stage VI being advanced osteoarthritis
    • Treatment options include:
      • Non-operative: protected weight-bearing and short-term bisphosphonates
      • Operative: core decompression, non-vascularized or vascularized grafts, osteotomy, and total hip arthroplasty (THA)

    Hip Instability

    • Hip instability can occur after a total hip arthroplasty (THA), with a higher incidence in revision procedures than in primary procedures.
    • Contributing factors include malpositioned acetabular or femoral components, poor soft tissue tension, and inadequate femoral offset.
    • THA dislocation presents with acute pain and loss of function
    • Acute dislocation of the THA is most common within the first 3 months after surgery
    • Initial treatment is reduction and bracing
    • Revision procedures address component malposition
    • Chronic dislocation occurs years after THA and is treated with reduction, bracing, and possible revision
    • Native hip dislocations are most commonly posterior and usually occur in high energy trauma. The prognosis can be poor if not treated promptly
    • Common diagnoses include:
      • Acetabular wall fracture
      • Femoral head fracture
    • Treatment for native hip dislocations includes prompt reduction, assessment for associated injuries, and strict hip precautions

    Stress Fractures of the Hip

    • Stress fractures are a common cause of pain in the hip region
    • Most frequently caused by repetitive stress with increased activity
    • Found in military recruits, long-distance runners and those on chronic bisphosphonate therapy
    • Diagnosis is made with bone scans and MRI
    • Treatment involves protected weight-bearing and potentially in-situ fixation or open reduction and internal fixation (ORIF)

    Hip Infections

    • Hip infections can occur in various populations, including young children, immunocompromised adults, and those who have undergone hip surgery
    • Common symptoms include pain, fever, decreased range of motion, and wound issues
    • Diagnosis is made with laboratory studies such as ESR, CRP, CBC, joint aspiration, and culture
    • Treatment depends on the severity of the infection, ranging from intravenous antibiotics and surgical drainage to resection arthroplasty
    • Treatment options include:
      • IV antibiotics, I&D, surgical debridement

    Heterotopic Ossification

    • Heterotopic ossification (HO) is bone formation in muscle and soft tissues
    • Commonly seen after trauma or surgery
    • Risk factors include prior hip fractures, dislocation, and hip replacement
    • Treatment options include prevention with indomethacin, low-dose irradiation, surgical excision, and postoperative irradiation
    • Rehabilitation is crucial in reducing restrictions and enhancing mobility.

    Pelvic Fractures

    • Pelvic fractures are typically caused by high-energy trauma, and complex fractures often require CT scan evaluation for diagnosis and treatment planning
    • The primary concern with pelvic fractures is associated life-threatening injuries
    • Pelvic fractures in elderly patients frequently occur due to low-energy falls
    • Rarely, insufficiency fractures can occur in individuals with weak bones

    Pelvic Fractures

    • Require CT scan
    • Lateral Compression
      • Ramus fracture
      • Sacrum fracture vs SI
    • Anterior-posterior Compression
      • Saddle Fracture/Symphysis
      • SI Disruption
    • Vertical shear
      • Anterior and posterior ring

    Pelvic Fractures - Treatment

    • Restore Pelvic Ring
      • Posterior SI Fixation
      • Anterior Ex-Fix/Plating
    • Protected WB for low-energy stable fracture patterns
    • Traction/pelvic sling - no longer used

    Acetabular Fractures

    • Intra-articular fractures
    • Can be associated with fractures of the femoral neck or shaft
    • Damage to the joint cartilage occurs with injury which leads to post-traumatic arthritis even with perfect reduction.

    Acetabular Fractures - Treatment

    • Anatomic reduction
    • Protected weight bearing

    Acetabular Fractures - Rehab

    • TTWB/NWB x 3 months
    • May have skeletal traction short term while awaiting surgery
    • Watch for pulmonary embolism

    Pelvic Fracture - Insufficiency

    • Older patient without significant injury history
    • May present with ossification on an initial X-ray with a minimally visible fracture
    • WBAT

    Young Hip Patient - Non-THA Surgery

    • Young patients present with hip pain that can be treated prior to THA

    Non-Prosthetic Hip Surgery

    • Intra-articular and peri-articular conditions can cause hip pain, restrict function, or predispose to secondary hip arthritis
    • Post-traumatic (Malunion/Nonunion)
    • Pre-arthritic (Dysplasia, SCFE, Perthes, AVN)
    • Intra-articular (Impingement, Labral Tear, Loose Bodies)

    Young Hip Patient - Assessment

    • History
      • Age, occupation, health, personality
      • Past hip problems - trauma/surgery/family history/risk
    • Symptoms
      • Pain (sitting, sleeping, activity)
      • Mechanical symptoms (locking)
      • Stiffness
      • Abductor fatigue
      • Position of Comfort

    Young Hip Patient - Imaging

    • X-rays
      • Pelvis (weight bearing)
      • Frog lateral
      • Dunn lateral
      • False profile
    • MRI (+/- Arthrogram)
    • CT Scan - bony detail

    Young Hip Patient - Non-THA Surgery - Femoral Osteotomy

    • Indicated for treatment of:
      • Proximal Femur Malunion/Nonunion
      • Post-traumatic OA / hip dysplasia (young patient)
      • AVN

    Young Hip Patient - Non-THA Surgery - Femoral Osteotomy - Rehab

    • Protect WB until bone healing
    • TTWB 6 weeks
    • Passive ROM x 6 weeks
    • 50% WB 6-12 weeks, active ROM, gentle strengthening
    • Full WB at 3 months, wean off assist as tolerated, aggressive strengthening especially abductors
    • Avoid sports x 1 year or longer

    Hip Arthrodesis (Fusion) - Indications

    • Young (15-30 years) active
    • Post-traumatic, infection
    • Abductors intact
    • Male, manual laborer
    • Normal back and knees

    Hip Arthrodesis - Technique

    • Anterior approach
      • Dynamic hip screw
      • Plate (single or dual)
    • Leg position
      • Flexed 15-30 degrees
      • Neutral abduction
      • Slight external rotation

    Hip Arthrodesis - Long Term

    • Adequate pain relief (in selective patients)
    • Complications
      • Ipsilateral Knee/Ankle
      • Contralateral hip
      • Lumbar spine
    • Can be converted to THA (difficult)

    Pre-Arthritic Hip Disease

    • Femoroacetabular impingement
    • DDH (Hip Dysplasia)
    • Slipped Capital Femoral Epiphysis (SCFE)
    • Perthes’

    Pre-Arthritic Hip Disease - Key Facts

    • 90% of patients have structural hip deformity
    • Joint preservation may prolong hip longevity (if performed before cartilage damage/arthritis)

    FAI - What is it?

    Hip Injuries

    • Damage to joint cartilage occurs with injury, leading to post-traumatic arthritis regardless of treatment.
    • Cartilage is sheared off during injury.
    • Watch for Pulmonary Embolism during treatment.

    Non-Displaced and Stable Fractures

    • Non-weight-bearing (NWB) or toe-touch weight-bearing (TTWB) for 12 weeks.

    Unstable or Displaced Fractures

    • Open reduction and internal fixation (ORIF) followed by TTWB for 10-12 weeks.
    • May require short-term skeletal traction before surgery.

    Pelvic Stress Fracture

    • Occurs in older patients with minimal injury history.
    • Characterized by ossification around the stress fracture, visible on bone scans.
    • Weight-bearing as tolerated (WBAT) with or without assistive devices.

    Non-Prosthetic Surgery of the Mature Hip

    • Deformity Correction: Treats pre-arthritic or early arthritic hip pain in young adults. Examples include Developmental Dysplasia of the Hip (DDH), Legg-Calvé-Perthes Disease, and slipped capital femoral epiphysis (SCFE).
    • Intra-articular & Peri-articular Pathology: Persistent source of hip pain, limiting function and increasing risk of osteoarthritis.
    • Non-prosthetic surgical techniques address a variety of adult hip joint problems.

    Intra-articular & Peri-articular Lesions

    • Examples include impingement syndromes, labral tears, and loose bodies.

    Post-Traumatic Hip Disorders

    • Include malunion, nonunion, and osteoarthritis (OA).

    Patient Evaluation for Hip Problems

    • History: Relevant patient history is crucial.
    • Physical Exam:
      • Gait analysis, leg length discrepancies, hip strength assessments, Trendelenburg sign, and range of motion evaluation.
      • Assess hip motion (limits and arc), as well as abductor strength.
      • Perform clinical tests to identify specific problems:
        • Impingement Test: Flexion, adduction, and internal rotation (IR) - groin pain indicates intra-articular pathology.
        • Apprehension Test: Hip extended with external rotation (ER) - tests for dysplasia (shallow acetabulum).
        • Bicycle Test: Assesses abductor function - performed in sidelying position.
    • Position of Comfort: Observe patient position in supine (lying on back) and weight-bearing.

    Imaging for Hip Evaluation

    • Plain radiographs: Weight-bearing pelvis, false profile (dysplasia), frog leg view, cross-table view, and functional views for joint congruency, space, and comfort.
    • MRI: Helpful for diagnosing osteonecrosis (ON) and avascular necrosis (AVN) with accuracy reaching 85%.
    • MRI arthrogram: Identifies intra-articular pathology, labral tears, with accuracy exceeding 85%.
    • CT scan: Provides detailed bony information, useful for ON, congruency, and osteophytes.

    Proximal Femoral Malunion

    • Strong indication for proximal femoral osteotomy to correct varus to valgus alignment of the head and neck.
    • Focuses on restoring normal anatomical relationships of the hip (length, offset, rotation, varus/valgus).
    • Wedge techniques are typically not used.

    Hip Dislocations

    • Unstable Total Hip Arthroplasty (THA):
      • Higher incidence of dislocation in revision THA compared to primary THA.
      • Primary THA dislocation: 1-5% incidence
      • Revision THA and complex primary THA: 7-15% incidence
      • Factors influencing dislocation:
        • Acetabular alignment
        • Femoral offset
        • Femoral length
        • Combined rotation
        • Soft tissue tension
      • Decreasing Dislocation Incidence:
        • Femoral components matching patient anatomy
        • Larger femoral heads
        • Dual mobility components
        • Soft tissue management
      • Timing and Treatment:
        • Acute Dislocations: Most occur within 3 months of THA, often due to breach of restrictions.
          • Initial treatment: Reduction and bracing; majority have no further issues.
          • Revisions: Indicate recurrent dislocation with malpositioned components.
        • Chronic Dislocations: Occurring years after THA, more prone to recurrence.
          • Initial treatment: Reduction and bracing.
          • Revisions: If components are malpositioned.

    Abduction Brace

    • Used to maintain the hip in a safe position during healing, allowing 30-60 degrees of flexion, 15 degrees of abduction, and neutral rotation.
    • Used for revision THA for 6 weeks to 6 months.

    Constrained (Locked) Acetabular Component

    • Employed for recurrent dislocations or instability, but prone to faster wear.

    Traumatic Dislocations (Native Hip)

    • Caused by high-energy trauma, most commonly motor vehicle accidents (MVA).
    • 85% are posterior dislocations, occurring from weight-bearing on a flexed hip.
    • Posterior dislocation: Often accompanied by acetabular wall fracture (if less than 60 years old, repair is recommended).
    • Femoral head fracture is also possible.

    Poor Prognosis for Traumatic Hip Dislocations

    • Associated with prolonged dislocation time, vascular disruption, sciatic nerve injury, and posterior cruciate ligament (PCL) knee injury.

    Treatment for Traumatic Hip Dislocations

    • Prompt reduction is crucial to preserve function.
    • Traction used to reduce the dislocation.
    • Return to ambulation with weight-bearing precautions.
    • Exercise within restrictions.

    Stress Fracture of the Hip

    • Occurs in the femoral neck, affecting military recruits, amenorrheic women, and long-distance runners.
    • Caused by repeated trauma or increased activity exceeding baseline.
    • Radiographic signs include the "dreaded black line" on radiographs or MRI.
    • Bone scan shows increased activity.
    • X-rays may show:
      • No abnormality.
      • Mild increase in bone density.
      • Linear radiolucency.
    • Treatment: Initially limiting weight-bearing, surgery as a last resort (ORIF).
    • Prognosis less optimal if fracture is on the tensile side of the bone.
    • Fractures extending across the bone require surgery.

    Infection of the Hip Joint

    • Surgical emergency.
    • Diagnosis:
      • Laboratory studies: Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), complete blood count (CBC).
      • Joint aspiration: Cell count and culture.
    • Treatment:
      • I & D (incision and drainage).
      • Hip Girdlestone Procedure: Performed for infected THA.
        • If infection identified within 24-48 hours, 75% chance of salvage with emergent I&D and prolonged antibiotics.
        • If infection present for longer periods, Girdlestone procedure removes all components and installs an antibiotic spacer.
          • Abduction brace used.
          • Protected weight-bearing.
          • IV antibiotics for 6 weeks to 6 months, followed by oral antibiotics for life.
          • Reimplantation may be possible later.

    Pelvic Fractures

    • Typically caused by high-energy trauma.
    • Often accompanied by multiple injuries, potentially life-threatening (intra-abdominal bleeding, urological, colorectal, chest injuries).
    • Complex fractures require CT scan evaluation.
    • Divided into pelvic ring fractures and acetabular fractures.
    • All pelvic injuries can involve ligamentous damage at the SI joint.
    • Imaging: Requires pelvic inlet, outlet, and AP views.

    Pelvic Ring Fractures

    • Classified by mechanism of injury:
      • Lateral compression: Caused by being hit by a car.
      • SI joint involvement.
      • Vertical shear: Always unstable.

    Pelvic Ring Fracture Treatment

    • Focuses on restoring pelvic ring stability.
    • Non-weight-bearing (NWB) for unstable fractures, weight-bearing as tolerated (WBAT) for stable fractures.
    • Traction/pelvic sling: Uncommon, only employed if medically unstable.
    • External fixation/plating: Anterior approach.
    • Open reduction and internal fixation (ORIF): Posterior SI joint.

    Acetabular Fractures

    • Intra-articular fractures requiring anatomic reduction.
    • Often associated with hip dislocation and/or femoral neck/shaft fracture.

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    MD Hip and Pelvis Lecture PDF

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    This quiz covers the classification of hip fractures, including high-energy and low-energy types, with a focus on the causes and risk factors associated with elderly patients. Additionally, it explores femoral neck fractures and their classification using the Garden system. Test your knowledge on these critical topics in orthopedics.

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